Office of Graduate Studies
1200 Commercial St.
Emporia, Kansas 66801
Voice: (620) 341-5403
Fax: (620) 341-5909
LETTER OF RECOMMENDATION FOR SCHOOL PSYCHOLOGY PROGRAM
Under the Family Educational Rights and Privacy Act, students of Emporia State University have the right to inspect their files upon
request. Sign one of the following statements so that the person you have requested to write a letter of recommendation will know if
their letter will be held in confidence, or if the letter will be open to your inspection upon your request. The waiving of your right to
see this letter of recommendation is not a requirement for admission.
□ I understand that I have the right to
inspect my file upon request under the
Family Educational Rights and Privacy
Act. I hereby WAIVE my right of
Access to this letter of recommendation.
Signature of Applicant
□ I DO NOT WAIVE my right of access
to this letter of recommendation.
Signature of Applicant
Part I
TO THE STUDENT: Complete Part I. Give this form to the person recommending you.
Name of Applicant:
Degree Sought:
If applicable, please list courses you have taken (or job experiences you have had) from the person filling out the reference.
Course Level
undergraduate/graduate
Course Title/Description or
Job Experience
When
completed
Grade/Performance
Please describe other personal or professional contacts you have had with the person giving reference:
Complete Part II. Next Page.
Please Return Completed form, pp. 1-2 to:
Attn: School Psychology Admissions Committee
Office of Graduate Studies
1200 Commercial St.
Emporia, Kansas 66801
Voice: (620) 341-5403
Fax: (620) 341-5909
Letter of Recommendation
02/11
Part II
TO PERSON FURNISHING REFERENCE: Please fill out this form and return it directly to ESU’s School Psychology Admissions
Committee via mail or fax as shown at the bottom of page 1. Please complete each rating below, and if you do not know the student
well or cannot judge any given area, please feel free to indicate this.
I do not know the student well enough to give a recommendation.
In what capacity and during what period of time have you known this applicant?
1. Please compare the applicant in the scale below with a representative group of students with whom you have interacted during your
career (please specify the reference group you are using, e.g., first year graduate students, seniors, employees, etc.)
Reference group
Exceptionally
Good
Very Good
Good; no major
weaknesses
Fair
Poor
Unable to judge
Overall intellectual ability
Capacity for critical thinking
Ability to work with others
Ability to work independently
Verbal communication skills
Written communication skills
Professional demeanor
Emotional stability/maturity
Ability to handle stress
Judgment and discretion
Capacity for self-reflection
Openness to feedback
Openness to diversity
__ I highly recommend
__ I recommend
__ I recommend with reservations
__ I do not recommend
Complete the following questions OR you may submit a LETTER OF REFERENCE WITH LETTERHEAD instead. If you submit
a Letter of Reference, please address your estimate of the applicant’s strengths and weaknesses as a graduate student in School
Psychology (e.g., intellectual independence, emotional maturity, capacity for analytical thinking, accomplishments, organizing and
expressing ideas, motivation, empathic abilities, effective listening and communication, etc).
2.
What information do you have about this applicant that is relevant to his/her pursuit of a degree/license in school psychology?
3.
On campus, in school and/or in the community, what contributions has the applicant made?
4.
Some with the potential to be satisfactory or exceptional graduate students have inconsistent or marginal academic records. Is
the applicant’s record an accurate index of his/her potential? ___Yes ___No ___ Do not know. If your answer is no, explain.
5.
Other comments on the applicant’s promise as a graduate student in school psychology?
Signature
Name (Typed or Printed)
Institution or Business
Date
Occupation, Positions, or Title
Contact info (MUST provide email and/or phone)
Letter of Recommendation
02/11